January 1

Neurophysiotherapy
2010
POST OPERATIVE SPINE REHABILITATION FOLLOWINGLUMBAR LAMINECTOMY Prepared by:
DHARAM PANI PANDEY P.T
Rehabilitation Guidelines for Physiotherapist BPT; MPT (Neurology); Ph.D. PT

JAIPUR GOLDEN HOSPITAL

Sector-3 Rohini, New Delhi-85
DEPARTMENT OF PHYSIOTHERAPY AND
REHABILITATION SCIENCES
 POST OPERATIVE SPINE REHABILITATION FOLLOWING
LUMBAR LAMINECTOMY
Rehabilitation Guidelines for Physiotherapist

PHASE I OF SPINE REHABILITATION(Inflammatory phase)

 Goals:
o Return to activities of daily living
o ROM exercises for LL
o Prevent post op DVT
o Allow/ facilitate healing
o Wound care
o Initiate supported walking
o Post op pain relief
o Normalization of flexibility deficits in extremities
o Patient education
o Improve positional tolerances

Exercises:
o Ankle pump
o Heal slide
o Isometric Quads/hams/gluteal
o Isometric abs/lumbar extensor
o Log Rolling
o Supine active assisted/ passive SLR ONLY IN PAIN FREE RANGE
o No spine rotation at this stage

Note: Remember at this phase main focus to be given to improve/facilitate healing and prevent complication not
strengthening.

PHASE II OF SPINE REHABILITATION (Recovery phase)

 Goals:
o Return to activities of daily living
o Functional dynamic lumbar stability
o Normalization of flexibility deficits in extremities
o Normalization of any gait deviations
o Patient education
o Improve positional tolerances for return to work

7th day to 4th week Post-Operative:

Start outpatient physical therapy
Back Education Program

 Reinforce neutral spine positioning

o Anatomy, Pathology, & Biomechanics
o Performance of functional activities with neutral spine and protective positions

Exercises:
All performed in neutral and protective positions

Lumbar Stabilization Program –

Facilitate neuromuscular control of lumbar spine
Supine progression with abdominal brace to without brace
o Single leg slides
o Bent and straight leg raises
o Toe tapping
o Supported dying bug
o Curl-ups with lumbar spine in protected position
o Diagonal curl-ups with lumbar spine in protected position
o Bridging progression
o Normal bridge with without (surgeon’s clearance required) abdominal brace with tiny steps with leg extension

Prone progression with abdominal brace to without brace

o Single arm or leg lifts
o Contralateral arm and leg lifts
o Bilateral arm and leg lifts
o Modified push-ups with neutral spine
o Quadruped progression
o Single arm or leg lifts
o Contralateral arm and leg lifts
PHASE III OF SPINE REHABILITATION(Muscle strengthening phase)
5th to 8th Weeks to Discharge

 Goals:
o Restore lumbar motion
o Normalize upper & lower extremity strength
o Improve cardiovascular function
o Decrease soft tissue dysfunction
o Improve positional work tolerances for return to work
o Functional Baseline Evaluation

Exercises
 Muscle Strengthening Program:
o To restore any upper and lower extremity strength deficit
 Dynamic Lumbar Stabilization:
 Continue to progress with stabilization exercise as indicated
 Flexibility:
o Continue with flexibility exercises as indicated
 Flexibility Exercises - in neutral and protective positions
 Hamstrings
 Quadriceps
 Iliopsoas
 Gastroc-soleus complex
 Hip internal and external rotators
 Gluteals and hip adductors
 Iliotibial band
 Quad lumborum and paraspinals
 Upper extremity musculature, as needed

 Aerobic Conditioning progressive walking, stair master swimming stationary bicycling, upper body ergometer

o Aquatic Exercise Program - to normalize any gait deviations, and perform strengthening activities with decreased axial
compression on the spine
o Functional stabilization exercises
o Pool walking - 4 directions
o Standing Progression
o Functional squats
o Leg lunges

Work Tolerance Positioning and Simulation –

 To begin focus on return to work/daily activities and function. Functional Baseline
 Evaluation performed.
 Soft Tissue Mobilization - For scar tissue management and areas of dysfunction
 Modalities - utilized only as required to meet established goals

PHASE IV OF SPINE REHABILITATION - WORK HARDENING

8th Weeks to Discharge
Goals:
o Restore lumbar motion
o Improve/normalize gait cycle
o Improve cardiovascular function
o Normalize upper and lower extremity strength
o Increase positional tolerance to 3-5 continuous full days (7-8 hours of job simulation required of his/her occupation and
demonstrates physical demands of the job utilizing proper body mechanics)
Job specific training
o Work Hardening –
 Progression into work hardening as appropriate (12 weeks post-op)
Exercise:
o Continue with flexibility, strengthening and cardiovascular exercises through a daily program
Work Tolerance:
o Increase patient's ability to perform a full day of activities
Work Simulation:
o Performance of work simulated tasks while reinforcing proper body mechanics
Flexibility Exercises:
o Continue with flexibility exercises as indicated.
Aquatic Exercise Program:
o To continue to assist with normalizing gait cycle and perform strengthening activities.
Walking Program
o Progressive walking program

Post Phase IV
Use of modalities and/or hands-on treatment is discouraged during this phase
Advanced strengthening and care education provided and discharged from program with home exercise program